Rizatriptan 10mg tablets

ObjectiveTo compare all licensed drug interventions as oral monotherapy for the acute treatment of migraine episodes in adults.DesignSystematic review and network meta-analysis.Data sourcesCochrane Central Register of Controlled Trials, Medline, Embase, ClinicalTrials.gov, EU Clinical Trials Register, WHO International Clinical Trials Registry Platform, as well as websites of regulatory agencies and pharmaceutical companies without language restrictions until 24 June 2023.MethodsScreening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Random effects network meta-analyses were conducted for the primary analyses. The primary outcomes were the proportion of participants who were pain-free at two hours post-dose and the proportion of participants with sustained pain freedom from two to 24 hours post-dose, both without the use of rescue drugs. Certainty of the evidence was graded using the confidence in network meta-analysis (CINeMA) online tool. Vitruvian plots were used to summarise findings. An international panel of clinicians and people with lived experience of migraine co-designed the study and interpreted the findings.Eligibility criteria for selecting studiesDouble blind randomised trials of adults (≥18 years) with a diagnosis of migraine according to the International Classification of Headache Disorders.Results137 randomised controlled trials comprising 89 445 participants allocated to one of 17 active interventions or placebo were included. All active interventions showed superior efficacy compared with placebo for pain freedom at two hours (odds ratios from 1.73 (95% confidence interval (CI) 1.27 to 2.34) for naratriptan to 5.19 (4.25 to 6.33) for eletriptan), and most of them also for sustained pain freedom to 24 hours (odds ratios from 1.71 (1.07 to 2.74) for celecoxib to 7.58 (2.58 to 22.27) for ibuprofen). In head-to-head comparisons between active interventions, eletriptan was the most effective drug for pain freedom at two hours (odds ratios from 1.46 (1.18 to 1.81) to 3.01 (2.13 to 4.25)), followed by rizatriptan (1.59 (1.18 to 2.17) to 2.44 (1.75 to 3.45)), sumatriptan (1.35 (1.03 to 1.75) to 2.04 (1.49 to 2.86)), and zolmitriptan (1.47 (1.04 to 2.08) to 1.96 (1.39 to 2.86)). For sustained pain freedom, the most efficacious interventions were eletriptan and ibuprofen (odds ratios from 1.41 (1.02 to 1.93) to 4.82 (1.31 to 17.67)). Confidence in accordance with CINeMA ranged from high to very low. Sensitivity analyses on Food and Drug Administration licensed doses only, high versus low doses, risk of bias, and moderate to severe headache at baseline confirmed the main findings for both primary and secondary outcomes.ConclusionsOverall, eletriptan, rizatriptan, sumatriptan, and zolmitriptan had the best profiles and they were more efficacious than the recently marketed drugs lasmiditan, rimegepant, and ubrogepant. Although cost effectiveness analyses are warranted and careful consideration should be given to patients with a high risk cardiovascular profile, the most effective triptans should be considered as preferred acute treatment for migraine and included in the WHO List of Essential Medicines to promote global accessibility and uniform standards of care.Systematic review registrationOpen Science Framework https://osf.io/kq3ys/.

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BackgroundMigraine in children and adolescents not only impacts academic pursuits and family life but also have secondary psychological effects. Determining the role of acute medication for migraine treatment in this population can reduce the burden associated with migraine. This network meta-analysis aimed to identify the relative efficacy and safety of acute migraine drug in children and adolescents migraine populations.MethodsThe Cochrane Register of Controlled Trials and MEDLINE via PubMed and Embase databases were searched from inception to August 2025, only published studies in English. Double-blind randomized clinical trials evaluating the currently available acute treatments for childhood and adolescent migraines were included. The primary efficacy endpoint was pain freedom at 2 hours. Secondary efficacy endpoints included the proportion of participants with pain relief at 2 hours, pain freedom from two to 24 h, and the proportion using rescue drugs after 2 hours and up to 24 h. Adverse events (AEs) were also evaluated.ResultsThe analysis included 30 studies (involving 8,914 participants and 13 pharmacological interventions). All treatments included demonstrated higher odds ratios (ORs) compared with the placebo for pain freedom at 2 hours. Dihydroergotamine was associated with the highest ORs, but its confidence interval included null values. Sumatriptan/naproxen sodium, ibuprofen, zolmitriptan nasal spray, sumatriptan nasal spray, and rizatriptan showed statistical significance. Sumatriptan/naproxen sodium yielded the highest odds (OR: 2.91, 95% CI: 1.87-4.53), followed by ibuprofen (OR: 2.88, 95% CI: 1.47-5.64), and rizatriptan showed the lowest (OR: 1.51, 95% CI: 1.23-1.86). Only sumatriptan/naproxen sodium was associated with a significantly higher OR compared with placebo for pain freedom from two to 24 h (OR: 2.31, 95% CI: 1.31-4.07). Ibuprofen exhibited the highest effect size for pain relief at 2 hours (OR: 3.21, 95% CI: 1.10-9.34). None of the included drugs was found to reduce the use of rescue drugs from two to 24 h. Zolmitriptan was associated with the highest risk of AEs among all treatments. Acetaminophen appears to have the lowest risk of adverse events, comparable to that of a placebo.ConclusionIbuprofen can effectively relieve symptoms, characterized by a favorable benefit-risk profile. Sumatriptan and zolmitriptan nasal sprays also exhibited robust efficacy, specifically among populations with prominent nausea and vomiting. Sumatriptan/naproxen sodium merits consideration, especially in patients exhibiting an inadequate response to monotherapy. Dihydroergotamine demonstrated potential benefits in refractory and chronic migraine; however, high-quality studies are warranted to validate these findings.

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IntroductionMenstrual migraine (MM) is a common subtype of migraine that greatly affects a woman's quality of life. A number of different drugs are used to treat menstrual migraine, but it is not known which is more effective.MethodsIn this study, we searched all randomized controlled trials that satisfied the inclusion and exclusion criteria up to December 2023 on PubMed, Embase and Cochrane Library using a suitable search strategy. We constructed a suitable network model for analysis after evaluating the heterogeneity among the included direct, indirect and pooled evidence. Odds ratio (OR) and corresponding 95% confidence intervals (CI) were used as valid indicators for this network meta-analysis.ResultsIn the Bayesian network model we constructed, we found that lasmiditan (vs. placebo OR, 14; 95% CI 3.1-100) was better than rizatriptan (vs. placebo OR, 1.9; 95% CI 1.2-3.3) in terms of the rate of sustained freedom from pain. There was no statistically significant difference between lasmiditan and different triptans in terms of the rate of being pain-free at 2 h (2-h pain-free) and the rate of pain relief at 2 h (2-h pain relief). Regarding safety, the probability of adverse events was significantly higher for rizatriptan (OR, 2.7; 95% CI 1.1-7.3) than for placebo.ConclusionIn terms of treatment efficacy for MM, lasmiditan was not worse than different triptans and was even better than some of the triptans in the rate of sustained freedom from pain. As an emerging treatment, lasmiditan is promising for the treatment of MM. However, more research needs to be carried out because of the lack of safety analysis for lasmiditan.

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BackgroundThis study compared persistence of patients initiating rimegepant versus oral triptans for the acute treatment of migraine.MethodsA retrospective cohort analysis was conducted using US MarketScan claims data (1 March 2019 to 30 June 2023) among commercially- and US federal Medicare-insured migraine patients initiating rimegepant or oral triptans. Persistence was defined as having ≥1 refill within 12 months of initial prescription and was compared between propensity score-matched rimegepant and triptan cohorts.ResultsBefore matching, 13,599 patients were identified in the rimegepant cohort and 38,127 in the triptan cohort. After matching, each cohort included 9909 patients. Significantly more rimegepant patients were persistent (75.8%) versus triptan patients (53.5%) (odds ratio [OR] 2.72, 95% confidence interval [CI] 2.56-2.90). Subgroup analyses showed similar trends for rimegepant versus specific triptans (rizatriptan: OR 2.49 [95% CI 2.33-2.67], and sumatriptan: OR 2.92 [95% CI 2.73-3.12]) and in patients with chronic migraine (OR 2.86 [95% CI 2.53-3.23]).ConclusionsThis study provides compelling evidence that rimegepant is associated with greater persistence than oral triptans for real-world acute treatment of migraine. Rimegepant is a favorable option for patients seeking effective and tolerable long-term treatment, particularly for those with insufficient response, intolerability, or contraindications to triptans.

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Reversible cerebral vasoconstriction syndrome is characterized by severe headaches and diffuse, segmental constriction of cerebral arteries. We report a rare pediatric case of triptan-induced reversible cerebral vasoconstriction syndrome, complicated by both subarachnoid hemorrhage and cerebral infarction. A 10-year-old boy presented with persistent severe headaches initially suspected to be migraines, for which he was prescribed rizatriptan. Five days after starting rizatriptan, he developed impaired consciousness (Japan Coma Scale 10) and partial right-sided hemiparesis, prompting emergency hospitalization. A head computed tomography scan revealed subarachnoid hemorrhage in the left frontal cortical region. Cerebral angiography showed stenotic changes in the internal carotid artery, middle cerebral artery, anterior cerebral artery, and posterior cerebral artery. Suspecting triptan-induced reversible cerebral vasoconstriction syndrome, rizatriptan was discontinued, and verapamil treatment was initiated. Subsequent magnetic resonance imaging and magnetic resonance angiography revealed cerebral infarction in the right cerebellum, left middle cerebral artery territory, and right occipital lobe, with persistent stenotic changes from earlier findings. Edaravone was added to the treatment regimen. The patient's condition gradually improved, and follow-up magnetic resonance angiography showed almost complete resolution of the prior stenotic changes. His partial right-sided hemiparesis nearly resolved, and he was discharged home. Triptans should be used with caution, as they may precipitate reversible cerebral vasoconstriction syndrome or exacerbate cerebral vasoconstriction. Careful monitoring and vascular imaging are essential for patients presenting with symptoms following triptan administration.

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